Yoga Under the Microscope

Most of us who love our yogic practices and enjoy their physical, emotional, and spiritual benefits don’t worry about why or how they work; we just do them. Some folks, however, can’t rest without hard evidence. They’re part of the push toward finding out whether alternative therapies, including yoga and meditation, have health benefits that can be measured.

The impulse to legitimize alternative medicine comes not only from some yogis, but from the U.S. government. The National Center for Complementary and Alternative Medicine (NCCAM), under the National Institutes of Health umbrella, wields a $78 million budget to promote rigorous scientific research that will bridge the gap between the broad use of complementary and alternative practices and the paucity of data demonstrating their safety and efficacy. NCCAM, which considers 350 different therapeutic methods as “alternative,” currently funds 104 projects, such as those studying the effect of acupuncture on back pain and the use of shark cartilage in the treatment of breast cancer. (Most NCCAM money goes to research centers, such as Maharishi University, Columbia University, and the Universities of Arizona, Michigan, and Maryland.) Having in the past funded studies on yoga for obsessive-compulsive disorder and as an enhancement for methadone maintenance treatment, NCCAM is currently funding a five-year, half-million-dollar study being conducted by the Oregon Center for Complementary and Alternative Medicine in Neurological Disorders (ORCCAMIND), in Portland. The ORCCAMIND study is investigating the effects of yoga on people with multiple sclerosis as well as the healthy elderly, specifically assessing such factors as alertness, ability to focus and shift attention, flexibility, balance, mood, quality of life, and (in the MS patients) fatigue.

Researchers pursuing the health benefits of yogic practices must compete not only for funding, but also to get their work published in reputable journals. You can be sure that the words “yoga” and “meditation” don’t appear often in the pages of the Journal of the American Medical Association, Allergy and Asthma Proceedings, or Stroke (a journal of the American Heart Association)but it does happen. We wanted to know who the scientists behind such studies areand what role yoga or meditation plays in their livesso we singled out three who’ve done research with important implications for public health and who’ve published in prestigious medical journals. They’ve hit the big time on behalf of yoga and the greater good.

Amparo Castillo-Richmond, M.D.

Taking TM to New Heights

Like many med school graduates, Amparo Castillo-Richmond, M.D., had lofty ideas about relieving suffering and helping people live healthful lives. But if you’d told her nearly 20 years ago, when she graduated from Javeriana University in her native Colombia, that she’d do that through research on Transcendental Meditation, not through traditional medicine, she might not have believed you.

In a clear demonstration of the maxim “Life is what happens while you’re busy making other plans,” Castillo-Richmond is not a small-town doctor in Colombia setting up family life with a fellow countryman as she once imagined; she lives in Iowa and is dedicating her career to studying the medical effects of TM. She’s the lead researcher on a widely reported study, done in conjunction with the University of California at Los Angeles, which reveals that TM can reduce the fatty buildup in artery wallsand can do it as effectively as drugs can. That TM reduces stress had already been well established; that TM can lower blood pressure in people with hypertension had also been documented. But Castillo-Richmond’s data, published in the March 2000 issue of Stroke, took TM research a leap forward.

Her randomized, controlled clinical trial on a group of African Americans with hypertension shows that 20 minutes of TM twice a day for just over five months actually reduced the thickness of the artery walls by nearly 1 millimeterwhich translates to a reduced risk for heart attack of 11 percent. (The control group, which was merely educated about prevention of heart disease, increased the fatty buildup in their artery wallsand their chance of having a stroke or heart attackin the same time period.) It’s a finding, she says, “better than I ever dreamed of.”

But back in 1982, when she graduated from medical school and began working as a clinician, all she knew about TM she had read in a newspaper ad featuring a photo of Maharishi Mahesh Yogi, who introduced the world to TM in the ’60s. Then, one night at a friend’s home, someone told her about the many positive changes that had come to his life since he began practicing TM. It was as if a light had been switched on. Immediately she thought, “This is what I need.”

As she began to integrate TM into her own life in Colombia, she also became increasingly frustrated in her medical practice. “I became disappointed,” she says, “with the lack of answers that modern medicine had to offer for even such simple ailments as gastritis. We were giving patients an antacidnothing else worked. Always the question in my mind was, ‘Are we dealing with the problem from the source?’”

Soon, she began looking to alternative medical therapies as a way to reach that source. She explored homeopathy, color therapy, pulse diagnosis, and a practice that uses the ear as a map for stress responses in the body. But these approaches also failed to satisfy her, because they lacked the scientific rigor she demanded. Discovering her deep interest in alternative therapies now makes her laugh. “After a while,” she says, “you don’t mind being out of the mainstream.”

Meanwhile, seeing the changes TM was bringing to her lifethe reduction of stress and anxiety, the clarity of mind and peacefulnessshe decided to leave Colombia in 1990 to study at the Center for Natural Medicine and Prevention at Maharishi University of Management’s College of Maharishi Vedic Medicine in Fairfield, Iowa. There, she figured, she could do serious research. And she was right. In 1995 she was offered a post-doctoral fellowship and given a piece of a large study, funded by National Heart, Lung, and Blood Institute grants, involving a battery of tests done on African Americans, who suffer disproportionately more than whites do from cardiovascular diseases. The study aimed to determine whether a stress-reduction intervention (specifically TM) or a heart disease education program is more effective in treating hypertension. Castillo-Richmond looked at one piece of the data: What changes could be seen in the thickness of the artery walls in subjects who practiced TM compared to those who received information about the prevention of heart disease and were told to spend 20 minutes daily in a leisure activity such as reading or exercising?

“Surprised and gladdened” by the large changes TM effected in the study, Castillo-Richmond is already involved in two follow-up studies directed by her team leader, Robert H. Schneider, M.D., and funded by NCCAM and the National Heart, Lung, and Blood Institute. These studies attempt to replicate her earlier findings with African Americans suffering from more serious heart disease. She’s excited about bringing TM to these at-risk subjects. “There is benefit for everyone with TM,” she says. “You only need to be able to think to experience the benefit from it.” She’s especially pleased that one of the studies involves older African American women, whom she calls “a highly neglected minority group.”

Soft-spoken and modest, Castillo-Richmond says, “I am the same person I was before I published the study results in Stroke, but I still wonder sometimes, ‘How did I get to be the channel of all that is written here?’ It makes me feel that I can do things that are good for me and good for everybody. I feel very honored and humbled. It is the work of many people, and I was happy to be part of it.”

Balancing her enthusiasm for TM with her knowledge of traditional medicine, she says, “We need both modern and alternative therapies.” And yet she points out that TM, in particular, can have far-ranging beneficial effects on the whole physiology and life of a person, as no drug or surgical intervention can. If patients and caregivers can begin to use TM as a tool in the treatment of cardiovascular diseasethe country’s number one killerthat will have a tremendous impact on the national health care system, she speculates. This simple technique, she says, has the potential to avoid risk and expense while saving lives. Changing the course of a disease with TM is possible, she says. “Now I want to make it probable.”

Marian Garfinkel, Ed.D.

Rx: Yoga for Joint Trouble

In 1998, on returning from her annual study with B.K.S. Iyengar, senior Iyengar Yoga teacher Marian S. Garfinkel, Ed.D., found over 900 e-mail messages waiting. Everyone from CNN to nurses in Texas to individuals in Poland were trying to reach her. For, just as she departed for India, the November 11 issue of The Journal of the American Medical Association had been released. In it was an article, with Garfinkel as the lead author, reporting on a study that set out to determine whether yoga postures based on the Iyengar method can relieve the symptoms of carpal tunnel syndrome, that common ailment resulting from repetitive activities like typing. The study’s conclusion: Yes, indeed, it can.

Trial subjects were recruited from a geriatric center and an industrial site; those who received yoga instruction twice a week from Garfinkel showed significant improvement in grip strength and suffered less pain than those who did not receive any yoga instruction. They also showed improvement on a nerve test used to measure the severity of carpal tunnel syndrome. Newspapers and television stations called Garfinkel to interview her about this surprising finding; health practitioners and individuals called to find out how they or their patients could relieve carpal tunnel symptoms with yoga.

Publication in that prestigious medical journal was the culmination of three years’ work for Garfinkelfrom getting the idea for the study, to designing the yoga intervention and lining up rheumatologists to help her, to finding grant money, and then submitting the article. Just as you don’t often see the word “yoga” in JAMA, you don’t see many Ed.D.sDoctors of Educationwriting JAMA articles. It is, after all, the leading journal for medical doctors. But Garfinkel is a “can do” sort of person. And listening to her talk about what she has done and is doing can make you feel like a couch potato even if you don’t own a TV.

Besides her Ed.D. (from the Department of Health Education at Temple University, where she also received certificates in gerontology and stress management), Garfinkel also has a Master’s degree in English literature and theater from Penn State University. (The same Marian Garfinkel who surfaced in JAMA wrote her master’s thesis on “The Fascist Tendencies of William Butler Yeats.”)

She also studied art appreciation at the Barnes Foundation, collects fine art, and has long been part of the Philadelphia art scene. And that’s not all; Garfinkel also serves on the board of the American Poetry Review and is a member of the Fine Arts Committee at the Morris Arboretum in Philadelphia. In her capacity as a health educator, she presents lectures and workshops on pain management, prevention, and treatment of arthritic disease and repetitive stress injuries, and teaches at the School of Nursing Education at MCP-Hahnemann University (also in Philadelphia). In her, um, spare time, she sings and loves to throw partiesnot backyard barbecues but fundraising galas for hundreds of people at a time. She’s even organized Philadelphia garden tours to raise money for arthritis research.

Then, of course, there’s yoga, her first love. She discovered yoga in the late ’60s and soon found herself teaching. In 1973, an Indian friend gave her a gift: a signed copy of B.K.S. Iyengar’s book Light on Yoga (Schocken, 1995). It presented a yoga unlike any that Garfinkel had known, and it both fascinated and scared her. No one taught Iyengar Yoga in Philadelphia then, and she could see that this yoga would require hard work, time, and practice. So, despite her responsibilities in Philadelphia, including a preschool-age son, she jumped at a chance in 1974 to meet Iyengar when she found he would be doing a workshop in Ann Arbor, Michigan. When, the evening before classes were to begin, she was introduced to him, he asked: “How can I help you?” She told him of coming to own a copy of his book, and said she’d like help with her Headstand. The next morning, Iyengar, red Brahmin stripe on his forehead, entered the hall where about 40 students were warming up in front of 100 or so observers. Garfinkel remembers that “he looked formidable, terrifying”nothing like the mild-mannered gentleman she’d met the night before.

He disrobed, jumped up on a table, called the class to order, and commanded, “Tadasana.” He moved directly to Garfinkel, tapped her on the shoulder and barked: “You want to stand on your head, and you don’t even know how to stand on your feet!” Four hours later Garfinkel hobbled out thinking, “I know nothing. How can I ever teach again after being around him?”

Nonetheless, in 1974 she began her annual treks to India to study, and with each visit her commitment to Iyengar Yoga has deepened. She’s had two different Iyengar Yoga studios, including her current one in downtown Philadelphia, where she teaches eight classes a week. And she’s now a trainer and assessor for Iyengar Yoga teacher certification.

In the early ’90s, while getting her doctorate, she began realizing her dream to use yoga to “make a contribution.” For her doctoral dissertation she conducted a field study looking at the effects of yoga on osteoarthritis of the hands and finger joints, which was published in the Journal of Rheumatology.

In post-graduate research, Garfinkel affiliated with the University of Pennsylvania under rheumatologist H. Ralph Schumacher, Jr., M.D., who mentored her study on carpal tunnel syndrome. “To help someone have less pain,” she says, “is a real act of grace.”

Her long-term hope is that Iyengar Yoga will become an accepted complementary medicine, and she’s doing her part to move it along. She’s now designing a study for osteoarthritis of the knee (again as a researcher under Schumacher at the University of Pennsylvania), and hopes to continue doing research and teaching yoga classes for patients with repetitive strain injuries (RSIs). That’s a show she’d like to take on the road, traveling to patients and health practitioners around the world, spreading the “very powerful art” of yoga.

Meantime, her life stays in high gear: She’s writing a book with another research physician from the University of Pennsylvania on RSIs, which will include yoga as a treatment. She’s continuing to lecture, teach, and present workshops on occupation-related health problems, to run her own studio and, most important, to practice. “From one’s own practice,” she says, “comes the greatest knowledge.”

P. K. Vedanthan, M.D.

Integrating East and West

The double-blind study is highly revered in mainstream medical research. In these classic studies, scientists divide subjects into two groups: One gets the treatment being tested (say, a new drug), the other gets a placebo (a little sugar pill that looks just like the real one), and neither the patients nor the testers know who got what until the results are in. Under this model, studies testing yoga’s effectiveness would have one group practicing yoga and the other…fake yoga?

“I don’t know how to do sham yoga,” says P. K. Vedanthan, M.D., of the Northern Colorado Allergy and Asthma Clinic in Fort Collins, Colorado. Nor does anyone else, which presents a problem for serious yoga researchers. Still, Vedanthan has been able to conduct and publish a single-blind study with some encouraging results for asthma sufferers.

His project divided adult asthmatics into two groups. Both kept daily diaries of their symptoms, medications, and peak flow readings. In addition, one group was given three 45-minute yoga classes a week, involving asanas, Pranayama, and meditation.

All the patients then filled out weekly symptom questionnaires, and were tested for pulmonary function and examined regularly by investigating physicians, who didn’t know which patients were doing yoga (thus, the “single-blind”-ness of the study).

At the end of four months, the yoga group reported significantly more relaxation and a more positive attitudeand tended to use their inhalers lessthan the control group.

This is just one of eight studies Vedanthan has done on yoga’s health benefits, bringing Western medical skepticism to the table. He’d heard claims, for instance, that yoga improves oxygenationthe amount of oxygen carried in the blood.

So he tested 11 patients, average age 72, with chronic obstructive pulmonary disease (COPD), who were on supplemental oxygen. For the test, they were taken off oxygen, which made their oxygen saturation immediately drop, and then given instruction for the practice of yoga breathing techniques and meditation, which made their oxygen levels rise. And all the patients reported an increased sense of well-being after the yoga.

Vedanthan thinks this indicates that yoga breathing techniques could be used as part of the pulmonary rehabilitation for patients with COPD.

Combining yoga with Western medicine might seem a natural for Vedanthan, who has yoga woven tightly into the fabric of his life, but it took time for him to reach that point.

As a boy growing up in India, he followed his father, grandfather, and entire family in making yoga a daily routine. But when he moved to the United States in 1970, after college, his focus was on studying medicine, not yoga.

He attended medical school in Mysore, India, with further training in pediatrics and internal medicine in Rhode Island, and later did a fellowship in allergy and immunology in Denver at what is now the National Jewish Center for Immunology and Respiratory Medicine. Then slowly, through years in private practice, specializing in asthma, his Eastern roots and Western medical training came together.

He’d been intrigued by the “hearsay” evidence of yoga’s medical benefits, and then in the mid-’80s he was approached by N. V. Raghuram, a senior yoga instructor, and his wife, S. Nagarathna, M.D., a researching physician at the Vivekananda Kendra Yoga Research Foundation in Bangalore, India.

The foundation had studied the use of yoga to treat such medical problems as high blood pressure, psychiatric ailments, eating disorders, and asthma, and the couple had traveled from India looking for a doctor who could do similar research here.

The proposal suited Vedanthan, and he’s been charging ahead ever since. Raghuram visits Vedanthan yearly; together they develop new studies, with Raghuram designing the therapeutic yoga to be used.

Vedanthan sees both benefits and drawbacks to doing research on yoga in Western culture. One problem, he says, is that some people here think that when you bring up yoga you’re trying to inculcate Hinduism.

“That is mostly ignorance,” he says. “The other side is that we prefer to do research in this culture, because patients and others here aren’t biased, as they are in India. There people assume yoga will help most anything.”

Vedanthan’s own yoga practice, 30 to 40 minutes daily, includes meditation and is “not as rigid” as it once was. He doesn’t worry, he says, about bending to touch his toes or about doing all the inverted poses he did as a young man. Instead, he focuses more on stretching and breathing and slowing his mind, to work on the inner body.

Looking ahead, Vedanthan hopes to conduct larger studies, with 50 or 60 patients, and to develop a center for integrated medicine in Fort Collins, incorporating other practitioners and other fields of medicine to spread this combination of East and West to ailments besides asthma.

One important aspect of yoga’s benefits that Vedanthan wants to bring to the forefront is its power to improve one’s quality of lifesomething that was rarely addressed in the medical literature in the ’80s when he began his research, but has since won more attention as an important component of overall health.

His studies so far seem to indicate that yoga helps to improve his patients’ sense of well-being in greater measure than the changes it makes in their pulmonary conditions. The importance of this cannot be dismissed: Earlier research indicates that asthma is more likely to kill patients who have negative attitudes and poor self-image.

Vedanthan was pleased to see the patients in his published study become more upbeat and watched as the majority of the non-yoga group started yoga practice when the study endedand he was even more pleased that some of those in the original study still practiced yoga five or six years later.

“They are motivated by their success,” he says, “and they continue.”

Ever the Western skeptic as well as the yoga devotee, Vedanthan tells his patients, “Add yoga to your medical regimen so your quality of life improves. You can’t say yoga is the answer for everything, but it has a place. Do it, and it will help.”

Freelancer Kathryn Black has written for a variety of magazines, including American Health, Family Circle, and Redbook. She is the author of the book In the Shadow of Polio: A Personal and Social History (Addison-Wesley, 1996). Black lives in Boulder, Colorado and has been practicing yoga since the 1970s.